1Traumatic Brain Injury

CEP 802AAshley ShahidullahNovember 3, 2011

2

Task Analysis

Step by step instructional guide to meet a goal

Chronological order Students can find and correct their own

errors Laminate and take home/ use

repeatedly

3

Task Analysis

Identify the lesson objectives Consider pre-requisite skills Identify key steps to understanding

concept Develop checklist for evaluation

4

Identifying triangles as isosceles, equilateral or scalene

What are the pre-requisite skills needed? Knowledge of geometric shapes/identify

shapes Triangles have 3 sides Triangles have 3 angles Knowledge of “equality” Understanding of measurement in length Ability to identify equal and unequal Identify isosceles, equilateral, and scalene

5

Order the Skills

1. Identify shapes2. Categorize shapes by number of sides3. Identify shapes with equal/unequal

sides4. Identify triangles as isosceles,

equilateral, scalene5. Visually represent isosceles,

equilateral, and scalene triangles6. Demonstrate abstract understanding of

elements of triangles (formulas, angles, etc)

6

Develop a Checklist for EvaluationSkill Master

edWorking on

Needs support

Identifies geometric shapes

Categorizes shapes by number of sides

Identifies shapes with equal/unequal sides

Identifies triangles as isosceles

Identifies triangles as equilateral

Identifies triangles as scalene

Visually represents isosceles, equilateral, and scalene triangles

Demonstrates abstract understanding of elements of triangles (formulas, angles, etc)

7

Addition of 2 digit numbers

What are the pre-requisite skills needed? Identifies place value through 10’s Understanding composing and decomposing

numbers One to one correspondence Uses manipulatives to demonstrate addition Demonstrates left to right in identifying

numbers Demonstrate addition as combining Identify addition symbol Understand + means combine

8

Order Them

1. One-to-one correspondence2. Use manipulatives to add3. Demonstrate addition as combining4. Reads 2 digit numbers from L to R5. Identifies place value6. Identifies + symbol means addition7. Decomposing and composing numbers

9

Group Work

Use the objective to complete a task analysis

List the pre-requisite skills or underlying concepts

Order the skills from low to high (concrete to abstract)

Create a checklist that could be used to evaluate student understanding of the objective

Email the checklist to me when finished

10

What is TBI?

11

True Lifehttp://www.mtv.com/videos/true-life-i-have-a-traumatic-brain-injury/1638298/playlist.jhtml

12

Individuals with Disabilities Education Act (IDEA) defines traumatic brain injury as…

“…an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.” [34 Code of Federal Regulations §300.8(c)(12)]

13

Causes

A blow to the head Can cause blood vessels to tear, creating a

pool of blood, which creates pressure on the brain

Can cause a bruise to the brain An object striking the head

Can break through the skull and penetrate the brain or push bone fragments into the brain

14

15

Brainstem

Regulates major life support functions

Injury can lead to… Slow thinking Easy fatigue Sleep disturbance Diminished

awareness Impaired balance

and coordination Loss of sensation

or movement

16

Frontal Lobe

Executive functions

Injury can lead to…

Impulse response

Little self-regulation

Initiation Delayed

decision making

17

Parietal Lobe

Processes the input of sensations from the body to the brain

“locator” circuits of the brain Injury can lead to… Perceptual

impairment Language

comprehension deficits

Safety issues Judgment disorder Difficulty making

sense of self and others

18

Temporal Lobe

Memory and emotional responses

Injury can lead to… Decrease ability

to interpret sounds

Sensitive hearing Excessive

emotions

19

Occipital Lobe

Sensory input from eyes

Injury can lead to… Problems

recognizing and identifying visual stimuli

20

National TBI

An estimated 1.7 million people a year

TBI is a contributing factor to a third (30.5%) of all injury-related deaths in the United States.

About 75% of TBIs that occur each year are concussions or other forms of mild TBI.

*The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.

21

Traumatic Brain Injury

Added to IDEA as an educational disability in 1990

Considered a high-incidence medical event Average annual incidence of 180 per 100,000

children under 15 Nat’l Pediatric Trauma Registry indicates that

68% are mild, 8% moderate, and 11.5% severe Approx 85% of children with TBI experience a

good outcome, 10% a moderate disability, and fewer than 5% a severe or profound disability

22

The number of students receiving special education services as a result of TBI is unknown.

There is enormous variability within this population based on Varying pre-injury profiles of ability Variable educational needs related

directly to the nature, location, and severity of the brain injury

Medical care Post-injury evolution of adjustment

and needs

23

Children with TBI are at risk of developing: Cognitive, emotional, and behavioral

impairments which may persist or even worsen over time

Behavioral problems such as: impulsivity, social disinihibition, hyperactivity, poor temper control, mood swings, and psychiatric disorders

24

What kinds of social behavior problems are symptoms of traumatic brain injury?

Impaired social behavior is a common nonacademic difficulty caused by TBI.

The most common of social behavior problems is the lack of inhibitions or the tendency to do and say inappropriate things.

After the TBI, those inappropriate behaviors are exhibited because the child’s control systems are no longer adequate to hold back the impulses (Lehr, 1997). Handling such behaviors is extremely challenging in the classroom.

25

What are typical cognitive effects of a traumatic brain injury in children?

The cognitive impairments that result from injuries produce academic difficulties by making the individual unable to do the job of being a student (Cohen, 1986).

The student no longer knows a way to read that will produce accurate comprehension and adequate learning

does not know how to take a test so that full knowledge is demonstrated.

Behavior no longer can be self-managed to satisfy teachers and get along with peers.

elementary tasks like packing a backpack for school, traveling from one class to another, and obeying school and classroom rules are no longer accomplished properly on a consistent basis.

26 Our brain helps us to think and

communicate, have feelings and actions, and move about the environment. When a child sustains a brain injury, these three major behaviors may become altered, changed, or lost forever. Thus, children may experience problems and need help in three major areas:

27

COGNITIVE NEEDS MAY INVOLVE Attention and concentration Thinking and reasoning Communication, language and

speech Memory, especially for learning new

information Judgment, decision making Planning, organization Ability to adjust to change Perception

28

PSYCHOSOCIAL NEEDS MAY INCLUDE Selfesteem, selfcontrol Awareness of self and others Awareness of social rules and roles Interest and social involvement Sexuality, appearance, grooming Family and peer relationships Ageappropriate behavior

29

SENSORIMOTOR NEEDS MAY INCLUDE Vision and hearing Spatial coordination Speed and coordination of

movements Balance and equilibrium Strength and endurance Speech Eye-hand coordination

30

The student needs to be taught another way to be a student, one that will be effective despite the impairments.

31

There are two ways of dealing with cognitive impairments. Change the environment so that it demands

less from the brain, lowering demands to the point that the impaired brain’s functioning is adequate. For example, criteria for a passing grade could be

lowered from 65% to 50% in order to accommodate the student’s cognitive impairment.

Instruction/training

32

Cognitive experts provide three theories of correction or remediation (Diller, 1987). The first, which is widely accepted and

probably the most popular, is described as “mental muscle” theory (Howard, 1997). Treatment consists of having the person practice the

skills that are impaired using repetitive or rote drills The second theory is developmental.

This theory holds that the injured person’s cognitive skills can be restored or relearned by retracing developmental learning increments and steps.

The third theory is neurobehavioral.

33

Address Cognitive ImpairmentsStudents need to be aware…

understand how his or her new brain differs from the old one

understand that success matters and that success should be tracked

facing challenges and sounding a warning before those challenges result in frustration

34

Address Cognitive Impairments

planning and writing the schedule for the day

following the same routine every day following a study system that plants new

memories• outlining and organizing thoughts and explanations

recording information so that it does not get forgotten or lost

using planning tools and techniques to get the big jobs done

implementing a self-reminder system.

35

Neurobehavioral seeks to restore practical abilities by rebuilding or

replacing the injured brain functions. This theory focuses on the ways in which the brain

combines, organizes, and structures information (Kosslyn & Koenig, 1992; Neisser, 1976; Pinker, 1997).

It looks at both the automatic and the deliberate aspects of mental activities (Schwartz & Begley, 2002).

Proponents of this theory believe that the child with a brain injury can be trained to correct the injured brain processes through the sequencing of instruction.

Instruction begins at the child’s present level of functioning and proceeds with incremental steps toward the overall goal.

36

Counseling or psychotherapy? More severe TBI, the greater the need

for specialized treatment and programs Key is to establish a plan quickly

37

What does this mean for children with TBI in school?

38

Environmental Modifications:

minimize extraneous auditory and visual stimulation (use study carrels or room dividers)

provide preferential seating arrange seating to allow for more space between

students provide small group instruction structure student's activities and schedule to limit

number of changes and reduce unstructured time limit number of persons that the student deals

with each day provide the student with a written schedule and

keep the schedule as consistent as possible provide area to keep supplies, books, etc., away

from student's work area select a classroom buddy

39

Learning Strategies

gain the student's attention before speaking break complex tasks down into component parts and

complete each part before trying to combine the components

provide frequent repetition of important tasks utilize the child's best sensory modality question student to be sure the information was

received and interpreted clearly and provide feedback as necessary

provide cueing systems in the form of assignment books, placing task cues on student's desk, etc.

40

Learning Strategies Continued… provide verbal and written instruction shorten assignments and/or divide assignments

into parts structure thinking processes graphically

through outlines, graphs, flow charts and models

develop a system for maintaining organization facilitate note taking by providing outlines with

major headings give short frequent quizzes, rather than all

inclusive exams accompany homework with written instructions initiate a behavior modification program for

academic and/or interpersonal behavior skills encouraging student to chart his or her progress.

41

TBI Characteristic

Instructional Strategy

Description

Fluctuating attention / decreased processing speed

Appropriate pacing

Delivering material in small increments and requiring responses at a rate consistent with student’s processing speed

Impaired memory

High rates of success

Acquisition and retention of new information tends to increase with high rates of success

High rates of failure /impaired organization / inefficient learning

Task analysis and advance organizational support

Careful organization of learning, tasks including systematic sequencing of teaching targets and advance organizational support

Inefficient learning/inconsistency

Sufficient practice and review

Acquisition and retention of new information is increased with review

42

Decreased self-awareness / Denial of deficits

Self-awareness/ attribution training

Facilitation of students’ understanding of their role in learning; validated for students with learning difficulties

Weak self-regulation related to frontal lobe injury / Disinhibited and potentially aggressive behavior

Cognitive behavior modification

Facilitation of self-control of behavior; validated with adolescents with ADHD and aggressive behavior

Impulsive behavior / inefficient learning from consequences

Positive, antecedent focused behavior supports

Approach to behavior management that focuses primarily on the causes or triggers of behavior

Frequent loss of friends / social isolation / weak social skills

Circle of Friends

A set of procedures designed to support students’ social life and ongoing social development

43

Lesson Plan

LBP form Lesson plan Student demographics Interactive technology Use one of the 5 co-teaching

strategies

Sign up for presentation day

44

Resources

NLVM http://www.pppst.com/ Florida Center for Reading Research

45

Next Class

Project 6- Submit on Angel 10 observations in Math Journal

46

References

Ylvisaker, M. et.al. (2001). Educating students with TBI: Themes and recommendations. Journal of Head Trauma Rehabilitation, 16, 76-93.

Hawley, C. A. (2004). Behaviour and school performance after brain injury.

Florida Department of Education (2005). Understanding and teaching students with traumatic brain injury: What families and teachers need to know. Bureau of Exceptional Education and Student Services.